Altered level of consciousness: occurs with acceleration-deceleration injuries and some focal injuries

COMA: can’t obey commands, can’t utter words, can’t open eyes

Glasgow Coma Scale: help to identify coma

Scores < 8 is severe brain injury

9-12 moderate brain injury

13-15 mild brain injury

Rancho Los Amigos Levels of Cognitive Functioning

Cognitive impairments of Neuromuscular Impairments

19

I am able to respond to your simple commands. When my mother walked in the room, I was easily distracted and then began to ramble about something that appeared off subject. I could not remember what you had just instructed me to do.

what level of RLA

Rancho Los Amigos

# 5

confused- inappropriate

20

I am responsive to speech; I follow most motor commands and I attempt to talk though my speech is confusing and not well put together. My score = ??

Make sure that ROM is being done to avoid contractures

Proper pelvic and head position

Use reclining or tilt in space wheelchair

May use splints

Exercise

PROM

Mobilize scapula

Watch joint mechanics at GH joint

LE ROM: especially ankle and hip

Do not do forceful motion: may increase risk of heterotopic ossification (other risk factors: trauma, increased muscular tone, paresis): abnormal formation of bone in mm and soft tissue, usually seen at more proximal joints

60

Improve arousal by??

Sensory stim: used to increase level of arousal and elicit movement

Attempting to increase stimulation in reticular activating system which will cause a general increase in arousal